Treatment of hydrocephalus at the Wessex Neurological Centre

Treatment of hydrocephalus at the Wessex Neurological Centre Mr Ryan Waters Ph. D FRCS (Neuro Surg) Consultant Neurosurgeon

Philosophy • To provide the highest quality service – Outcomes – Patient experience • Collaborative approach – Network partnerships with; • Our referring Trusts • Oxford Children’s Hospital (Children’s Hospital Network) – Third largest unit in the UK

Southampton Staff • • Owen Sparrow Nijaguna Mathad Aabir Chakraborty Ryan Waters Christine Ward (Nurse practitioner) 13 Paediatric Neurosciences nurses Peter Gladwell (Surgical Practitioner)

Hydrocephalus • “An abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain” • but not the whole story?

Classification • Non-communicating/obstructive – CSF flow obstruction – Aqueduct stenosis – Tumour – Haemorrhage • Communicating – Absorption problem – – Haemorrhage Infection Tumour Inflammation – ‘normal pressure hydrocephalus’ – IIH

Common causes of hydrocephalus

Causes Post head injury Tumour

Patient Assessment-History & Examination • Is the child Unwell? – Vomiting – Drowsiness – Headaches – School performance – Head circumference – Fontanelle – Bradycardia/apnoeas – Squint – Sunsetting

Treatment options • Treat the underlying cause • Temporary CSF drainage – Lumbar puncture – Ventricular tap – EVD • Endoscopic IIIrd ventriculostomy • Shunt – VP – VA – VPleural

ETV

Shunt

Shunt hardware

Proximal and Distal Tubing Selection • Antibiotic impregnated catheters – Bactiseal – Silverline • More than 20 studies on Bactiseal – Some evidence that Bactiseal reduces shunt infections – Need for a multicentre randomised controlled study - BASICS

Shunt Blockage Southampton Children's Hospital

Shunt Malfunction

Shunt Disconnection Southampton Children's Hospital

Southampton Children's Hospital

Diagnostic Shunt Tap • Aseptic Technique • Measure Opening Pressure • If Possible Remove Adequate Volume of CSF • Send Specimens to Chem, Micro & Culture NB Facilitated by System with Reservoir Southampton Children's Hospital

Normal Pressure Hydrocephalus • Generally seen in older adults • Communicating hydrocephalus • Clinical triad – Cognitive decline – Gait disturbance – Urinary incontinence • Ventriculomegaly on imaging

Investigation at WNC • MDT with neurology, neuropsychology, neurosurgery • Assessment – Neuropsychology – Walking test – CSF infusion test – CSF drainage

Treatment at WNC • VP shunt – Programmable valve – Risk of overdrainage and subdural formation

Idiopathic Intracranial Hypertension • Not ‘hydrocephalus’ but often treated with a shunt – A venous disorder • Multidisciplinary approach; neurology, neurosurgery and neuroradiology – Venography, manometry and stenting where possible – but shunts still used to control ICP